Problem solved

My son, who is 18, shows signs of anorexia. In one year, he has lost 5kg. I had an acrimonious divorce in 2003, and the children and I had to move a lot. Also, his adopted older brother died because of drug abuse in 2008.

He now avoids any social occasion, saying: "If you have lunch I won't have any, anyway."

I telephoned the medical services at his university, and was told: "We can only do so much. The person has to come to us."

He spends all his holidays in Morocco with his father, where he sees himself in the role of carer because his father has diabetes and tinnitus.

I fear any approach I make to help my son will be rebuffed. Yet I see his internal suffering reflected in his refusal to eat. Anon, via email

You sound very sensitive and insightful about his condition. The first thing would be to get a proper diagnosis so he could not only access treatment, but anything else could be ruled out. I appreciate this is not easy, for all the reasons you have stated. You cannot force someone with an eating disorder (of which anorexia is just one) to get treatment unless their condition is at a life-threatening stage. So your first port of call is your GP, and I do hope you have one who is sensitive about eating disorders.

I spoke to Professor John Morgan, a psychiatrist who is vice-chairman of the eating disorders section at the Royal College of Psychiatrists, and author of The Invisible Man: A Self-help Guide for Men with Eating Disorders. He explained that the best way to help is to understand it from the sufferer's point of view, which is that anorexia is experienced – at least initially – as helpful and healing; it serves a purpose for the sufferer.

You are right to be cautious about your approach because telling them how much they are damaging themselves, for example, can backfire. Anorexia is an incredibly tenacious mental illness and an egosyntonic one – in other words, people who have it do not see that they have a problem.

Some people can be predisposed to anorexia (it can be a genetic predisposition or personality type combined with low self-esteem and a desire for perfectionism), and then a traumatic event can trigger it. But it is ultimately an illness about control and managing difficult emotions that cannot be processed in another way. So your last line is spot on.

What can you do? Professor Morgan suggests being there for your son, but striking a balance between becoming too involved (this could be counter-productive because you may find it hard not to hector) and not involved enough. Your son needs to see that what he has is an illness, not a way of coping, but he has to find this out for himself. This can take anorexics anything from six months to many years.

You could try subtly directing him to beneficial websites (beware, there are a lot of damaging, pro-anorexia sites). I urge you to visit Beat (beating eating disorders). There are helpful links on how to get help for you and your son, as well as information on what an eating disorder is. There is also a helpline, 0845 634 1414 (for over 18s), or 0845 634 7650 for those 25 and under. You can also email, if you prefer.

What is your ex-husband's take on all this and why is your son acting as his carer? Diabetes and tinnitus are usually conditions that can be managed perfectly well by the person who has them. Also – and I don't want this to be a curve ball, just something for you to think about – while it is mostly heterosexual men who get eating disorders, sexual orientation can be a "significant factor" according to Beat.